‘Hydro‐point’ – The forgotten and unspoken entity in hydropneumothorax

Abstract

Effusive pneumothorax is an abnormal collection of air and fluid within the pleural space: blood, pus, or serous fluid. Thus, effusive pneumothorax can be categorized as hemopneumothorax, pyopneumothorax, or hydropneumothorax, depending on the type of fluid accumulation. Hydropneumothorax is a clinical condition defined by the presence of air and serous fluid within the pleura space. Hydropneumothorax is one of the common respiratory emergencies encountered in the emergency department in India. Etiologies can be classified into infectious and non‐infectious causes, among which tuberculosis being the most common one. Point of care ultrasound (POCUS) can help diagnose hydropneumothorax at the bedside rather than shift the patient for an X‐ray. Here, we describe a case of hydropneumothorax, which was diagnosed using POCUS by characteristic sonographic signs, namely “Hydro‐point” and “barcode‐hydro point‐sinusoidal sign.” Sonographic hydro‐point is the transition zone of the air‐fluid interface, which is seen in hydropneumothorax. Targhetta et al., in 1992, introduced the term “Hydro‐point” in lung ultrasound for diagnosing hydropneumothorax but has been under‐reported/unspoken much in the literature. With the use of POCUS, we diagnosed and stabilized the patient in the Emergency Department.

Defective barcode sign – A newer sonographic sign in hydropneumothorax

“…When hydrothorax and pneumothorax coincide within the pleural cavity, they produce a characteristic air–fluid interface pattern called “hydro point.”[ 3 4 ] The sonographic dynamicity of hydro point is called dynamic air–fluid interface sign. [ 5 ] The severity of hydropneumothorax can be assessed sonographically using hydro point location. When the lung is screened anteroposteriorly in the supine position, if the hydro point is more anterior, the effusion component is more than pneumothorax and vice versa.…”

“…This can be viewed by screening the lung from dependent zone to the nondependent zone using high-frequency linear probe. This sonographic sign of hydropneumothorax is called as “barcode – hydro point - effusion sign.”[ 5 ]…”